Editing Muscle-Invasive Bladder Cancer (section)

==Follow-up<span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/28456635/ ★]</span>==
*'''<span style="color:#ff0000">Imaging</span>'''
** '''<span style="color:#ff0000">Chest and cross-sectional imaging of the abdomen and pelvis (CT or MRI): 6-12 month intervals for 2-3 years and then may continue annually</span>'''
***The overall prevalence of upper tract urothelial carcinoma after cystectomy ranges from 1-6%
***'''Cross sectional imaging is preferably with intravenous contrast and delayed images to evaluate the collecting system and also other sites of disease.'''
***'''Imaging beyond 5 years should be based on shared decision making''' between the patient and clinician.
*'''<span style="color:#ff0000">Laboratory values and urine markers</span>'''
**'''<span style="color:#ff0000">Following therapy for MIBC, patients should undergo laboratory assessment of electrolytes, renal function, +/- vitamin B12 at 3-6 month intervals for 2-3 years and then annually thereafter</span>'''
***Patients may experience metabolic derangements and declines in renal function over time associated with urinary diversion
***'''Vitamin B12 levels should be assessed in patients with resection of > 60 cm of ileum and in those patients in whom the terminal ileum''' is utilized as there is an increased risk of deficiency and consequent neurological damage
***'''<span style="color:#ff0000">Routine frequent CBC and liver function testing for cancer surveillance has not been validated</span>'''
***'''Insufficient data to support the routine use of cytology''' or urine-based tumor markers in detection of upper tract urothelial cancers
****Urine collected from intestinal urinary diversion or previously irradiated bladders may contain desquamated intestinal epithelial cells or atypia due to therapy, which may lower the diagnostic specificity.
**'''<span style="color:#ff0000">In patients with a retained urethra following radical cystectomy, the urethral remnant should be monitored for recurrence</span>'''
***'''Urethral wash cytology''' may be a valuable tool in higher risk patients with a retained urethra. This should be considered during follow up, and patients should undergo '''physical examination of the urethra''' and '''discussion of any urethral symptoms such as urethral discharge or spotting'''.

*Patient survivorship
**Clinicians should discuss with patients how they are coping with their bladder cancer diagnosis and treatment and should recommend that patients consider participating in a cancer support group or consider receiving individual counseling.
**Clinicians should encourage bladder cancer patients to adopt healthy lifestyle habits, including smoking cessation, exercise, and a healthy diet, to improve long-term health and quality of life.